Healthcare Provider Details

I. General information

NPI: 1184662652
Provider Name (Legal Business Name): JOHN C FREMONT HEALTHCARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5189 HOSPITAL RD
MARIPOSA CA
95338-9524
US

IV. Provider business mailing address

PO BOX 216
MARIPOSA CA
95338-0216
US

V. Phone/Fax

Practice location:
  • Phone: 209-966-3631
  • Fax: 209-966-3776
Mailing address:
  • Phone: 209-966-3631
  • Fax: 209-966-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number040000108
License Number StateCA

VIII. Authorized Official

Name: ALAN G MACPHEE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 209-966-3631